Comorbid alcoholism and depression: treatment issues.

Unless there is decisive professional intervention, people who suffer from both a depressive disorder and alcoholism are at great risk of chronic impairment, both at home and in the workplace; persistent symptomatic misery; and premature death. Untreated alcoholism intensifies depressive states, decreases responsiveness to conventional therapeutics, and increases the likelihood of suicide, suicide attempts, and other self-destructive behavior. During the past decade, evidence has emerged from placebo-controlled studies supporting the utility of tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) for treatment of depressed alcoholics. The superior safety and tolerability of SSRIs provide strong justification for their first-line use despite higher drug acquisition costs. Evidence has similarly emerged concerning the use of several novel pharmacotherapies and focused psychotherapies for people with alcoholism. These newer therapeutic options complement more traditional intervention such as chemical dependence counseling, disulfiram, and Alcoholics Anonymous so that it is now possible for a majority of depressed alcoholics to be treated effectively. The availability of effective treatments provides further impetus for health care professionals to improve recognition of comorbid alcoholism and depressive disorders. Improved recognition and treatment will save lives, and the benefits are likely to extend across generations.